Machine Perfusion of Kidneys Donated After Circulatory Death

Jochmans, Ina; Pirenne, Jacques

doi:10.1016/b978-0-12-398523-1.00016-1

Cited by 3 publications

(4 citation statements)

References 89 publications

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“…In parallel to this trial in ECD kidney transplant, another prospective randomized clinical trial by Consortium for Organ Preservation in Europe has directly compared continuous oxygenated vs nonoxygenated HMP in paired donor kidneys from the moment of procurement until implantation . This study found that prolonged oxygenated HMP provides significantly better results in donation after circulatory death kidneys compared with standard HMP, showing a lower rate of graft failure, reduction in incidence of acute rejection, and better estimated glomerular filtration rate at 12 months after kidney transplant …”

Section: Discussionmentioning

confidence: 99%

Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant

et al. 2021

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IMPORTANCE Continuous hypothermic machine perfusion during organ preservation has a beneficial effect on graft function and survival in kidney transplant when compared with static cold storage (SCS).OBJECTIVE To compare the effect of short-term oxygenated hypothermic machine perfusion preservation (end-HMPO 2 ) after SCS vs SCS alone on 1-year graft survival in expanded criteria donor kidneys from donors who are brain dead. DESIGN, SETTING, AND PARTICIPANTSIn a prospective, randomized, multicenter trial, kidneys from expanded criteria donors were randomized to either SCS alone or SCS followed by end-HMPO 2 prior to implantation with a minimum machine perfusion time of 120 minutes. Kidneys were randomized between January 2015 and May 2018, and analysis began May 2019. Analysis was intention to treat.INTERVENTIONS On randomization and before implantation, deceased donor kidneys were either kept on SCS or placed on HMPO 2 .MAIN OUTCOME AND MEASURES Primary end point was 1-year graft survival, with delayed graft function, primary nonfunction, acute rejection, estimated glomerular filtration rate, and patient survival as secondary end points. RESULTSCenters in 5 European countries randomized 305 kidneys (median [range] donor age, 64 [50-84] years), of which 262 kidneys (127 [48.5%] in the end-HMPO 2 group vs 135 [51.5%] in the SCS group) were successfully transplanted. Median (range) cold ischemia time was 13.2 (5.1-28.7) hours in the end-HMPO 2 group and 12.9 (4-29.2) hours in the SCS group; median (range) duration in the end-HMPO 2 group was 4.7 (0.8-17.1) hours. One-year graft survival was 92.1% (n = 117) in the end-HMPO 2 group vs 93.3% (n = 126) in the SCS group (95% CI, −7.5 to 5.1; P = .71). The secondary end point analysis showed no significant between-group differences for delayed graft function, primary nonfunction, estimated glomerular filtration rate, and acute rejection.CONCLUSIONS AND RELEVANCE Reconditioning of expanded criteria donor kidneys from donors who are brain dead using end-HMPO 2 after SCS does not improve graft survival or function compared with SCS alone. This study is underpowered owing to the high overall graft survival rate, limiting interpretation.

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Section: Discussionmentioning

confidence: 99%

Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant

et al. 2021

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“…Besides the Airdrive, the KidneyAssist has been designed to oxygenate the perfusion fluid by using a combination of 100% medical oxygen and a hollow-fiber oxygenator (390 cm 2 ), reaching a maximum oxygen pressure of 600 mm Hg in the perfusate [20]. A recent RCT, which compared oxygenated HMP with non-oxygenated HMP, showed a 1-year graft survival benefit for transplanted DCD kidneys preserved by oxygenated HMP [21]. This suggests that oxygenation of the perfusion fluid may also be an advantage of the Airdrive HMP.…”

Section: Discussionmentioning

confidence: 99%

The Use of the Oxygenated Airdrive<sup>TM</sup> Machine Perfusion System in Kidney Graft Preservation: A Clinical Pilot Study

et al. 2020

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Background: The shortage of donor kidneys has led to the use of marginal donors, e.g., those whose kidneys are donated after circulatory death. Preservation of the graft by hypothermic machine perfusion (HMP) provides a viable solution to reduce warm ischemic damage. This pilot study was undertaken to assess the feasibility and patient safety of the AirdriveTM HMP system in clinical kidney transplantation. Methods: Five deceased-donor kidneys were preserved using the oxygenated Airdrive HMP system between arrival at the recipient center (Amsterdam UMC) and implantation in the patient. The main study end-points were adverse effects due to the use of Airdrive HMP. Secondary end-points were clinical outcomes and perfusion parameters. All events occurring during the transplantation procedure or within 1 month of follow-up were monitored. Results: Five patients were included in this pilot study. No technical failures were observed during the preservation period using the Airdrive HMP. Mean perfusion parameters were: duration 8.5 h (3–15 h), pressure 25 mm Hg (18–25 mm Hg), flow 49.77 mL/min (19–58 mL/min), resistance 0.57 mm Hg/min/mL (0.34–1.3 mm Hg/min/mL), and temperature 8.2 °C (2–13°C). Mean cold ischemia time (CIT) was 20.2 h (11–29.5 h). No adverse events or technical failures were observed during preservation and transplantation or during the 1-month follow-up. Conclusions: This pilot study showed the feasibility of the use of the Airdrive HMP system with no adverse events in clinical kidney transplantation.

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“…The first clinical use of ex-situ machine perfusion (MP) was reported with kidneys by Folkert Belzer and his group in 1965 6 . This method became, however, quickly replaced when the benefits of advanced storage solutions were shown by Collins and Belzer 7,8 . The simple technique of static cold storage (SCS) was born and enabled the successful preservation of standard abdominal human organs for transplantation for up to 30 hours, a more cost-efficient and convenient methodology at that time.…”

Section: Introductionmentioning

confidence: 99%

“…[6] This method became, however, quickly replaced when the benefits of advanced storage solutions were shown by Collins and Belzer. [7,8] The simple technique of static cold storage (SCS) was born and enabled the successful preservation of standard abdominal human organs for transplantation for up to 30 hours, a more cost-efficient and convenient methodology at that time. With an increasing number of waitlist candidates and everdeteriorating donor profiles, the inherent disadvantages of SCS became evident.…”

Section: Introductionmentioning

confidence: 99%

Obstacles to implement machine perfusion technology in routine clinical practice of transplantation: Why are we not there yet?

et al. 2023

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Machine perfusion of solid human organs is an old technique, and the basic principles were presented as early as 1855 by Claude Barnard. More than 50 years ago, the first perfusion system was used in clinical kidney transplantation. Despite the well-known benefits of dynamic organ preservation and significant medical and technical development in the last decades, perfusion devices are still not in routine use. This article describes the various challenges to implement this technology in practice, critically analyzing the role of all involved stakeholders, including clinicians, hospitals, regulatory, and industry, on the background of regional differences worldwide. The clinical need for this technology is discussed first, followed by the current status of research and the impact of costs and regulations.Considering the need for strong collaborations between clinical users, regulatory bodies, and industry, integrated road maps and pathways required to achieve a wider implementation are presented. The role of research development, clear regulatory pathways, and the need for more

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Machine Perfusion of Kidneys Donated After Circulatory Death

Cited by 3 publications

References 89 publications

Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant

Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant

The Use of the Oxygenated Airdrive<sup>TM</sup> Machine Perfusion System in Kidney Graft Preservation: A Clinical Pilot Study

Obstacles to implement machine perfusion technology in routine clinical practice of transplantation: Why are we not there yet?

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